Provider Demographics
NPI:1659527539
Name:MCKEE, LISA MAIRE (DDS)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MAIRE
Last Name:MCKEE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6224 S. MAIN STREET
Mailing Address - Street 2:C
Mailing Address - City:DOWNERS GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60516-1986
Mailing Address - Country:US
Mailing Address - Phone:630-963-1458
Mailing Address - Fax:630-963-5510
Practice Address - Street 1:6224 MAIN ST
Practice Address - Street 2:C
Practice Address - City:DOWNERS GROVE
Practice Address - State:IL
Practice Address - Zip Code:60516-1900
Practice Address - Country:US
Practice Address - Phone:630-963-1458
Practice Address - Fax:630-963-5510
Is Sole Proprietor?:No
Enumeration Date:2008-08-12
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190198291223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics